Decision Support Techniques

ABCIC

Case Report

Percutaneous Mitral Repair with MitraClip® as an Adjunct Therapy of Heart Failure

Petherson Susano Grativvol et al. Katiuska Massucatti Grativvol Alberto de Paula Nogueira Jr João Eduardo Tinoco de Paula Antonio Carlos Botelho da Silva

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IJCS

Original Article

SAMe-TT2R2 Score: A Useful Tool in Oral Anticoagulation Decision-Making for Venous Thromboembolism Patients?

Fernando Pivatto Júnior et al. Rafaela Fenalti Salla Lísia Cunha Cé Andréia Biolo … André Luís Ferreira Azeredo da Silva Bruno Führ Luís Carlos Amon Marina Bergamini Blaya Rafael Selbach Scheffel

Abstract

Background:

The SAMe-TT₂R₂ score was introduced to identify atrial fibrillation patients with a high risk of not achieving a good time in therapeutic range (TTR) during vitamin K antagonists (VKA) therapy.

Objective:

The aim of this study was to evaluate this score in venous thromboembolism (VTE) patients.

Patients and methods:

A retrospective cohort study of patients receiving care at the outpatient anticoagulation clinic of a tertiary care teaching hospital. Patients were classified as having low (score 0-1) or high risk (score ≥ 2) of not achieving a good TTR. The area under the ROC curve was calculated to assess the ability of the score to predict a TTR ≥ 65%. Adverse event-free survival curves according to the SAMe-TT₂R₂ score were calculated by the Kaplan-Meier method and compared by the log-rank test. A p-value < 0.05 was considered statistically significant.

Results:

We investigated 111 patients during a median follow-up of 2.3 (0.7-6.4) years. Mean age was 54.1 ± 15.7 years and 71 (64.0%) were women. Low- and high-risk groups had similar mean TTR (51.9 vs. 49.6%; p = 0.593). The two groups did not differ significantly in the percentage of patients achieving a TTR ≥ 65% (35.6 vs. 25.8%; p = 0.370). The c-statistic was 0.595 (p = 0.113) for TTR ≥ 65%. Adverse event-free survival during anticoagulation was also similar in both groups (p = 0.136).

Conclusions:

The SAMe-TT₂R₂ score does not seem to be a useful tool in oral anticoagulation decision-making for patients with VTE and should not be used in this setting.

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ABC

Viewpoint

Prediction Models for Decision-Making on Chagas Disease

Fernanda de Souza Nogueira Sardinha Mendes et al. Pedro Emmanuel Alvarenga Americano do Brasil

To investigate the relationship between future or unknown outcomes and baseline health states among people with specific conditions, prediction models are an interesting strategy used to assist diagnosis, prognosis and treatment. They estimate the likelihood of clinical events taking into account clinical relevant measures and complementary tests. These predictors and their importance vary between the different events of interest and their prediction ability varies when considered singly or in combination with other predictors. They may facilitate simple and direct comparisons of risks, individualize treatment regimens, and may refine prognosis stratification of patients, especially when many prognostic factors are known. Models have to be simple, easy to use and lead the clinician to make decisions which are more likely to bring benefit to the patients.

The World Health Organization estimates that 7-8 million people worldwide are infected with T.cruzi. Chagas disease is endemic in Latin America and the immigration pattern in the past years has made this disease an important health issue in many countries. In United States, more than 300,000 individuals might be infected and one study estimated that 3.5% of immigrants to Canada from Latin America were infected. Physicians should be able to recognize signs and symptoms of Chagas disease as globalization increase the burden of this disease in non-Latin American countries, where vector transmission is unlikely to occur.

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ABC

Original Article

SAMe-TT2R2 Score in the Outpatient Anticoagulation Clinic to Predict Time in Therapeutic Range and Adverse Events

Fernando Pivatto Júnior et al. Rafael Selbach Scheffel Lucas Ries Ricardo Roitman Wolkind … Roberta Marobin Sabrina Sigal Barkan Luís Carlos Amon Andréia Biolo

Abstract

Background:

The SAMe-TT₂R₂ score was developed to predict which patients on oral anticoagulation with vitamin K antagonists (VKAs) will reach an adequate time in therapeutic range (TTR) (> 65%-70%). Studies have reported a relationship between this score and the occurrence of adverse events.

Objective:

To describe the TTR according to the score, in addition to relating the score obtained with the occurrence of adverse events in patients with nonvalvular atrial fibrillation (AF) on oral anticoagulation with VKAs.

Methods:

Retrospective cohort study including patients with nonvalvular AF attending an outpatient anticoagulation clinic of a tertiary hospital. Visits to the outpatient clinic and emergency, as well as hospital admissions to the institution, during 2014 were evaluated. The TTR was calculated through the Rosendaal´s method.

Results:

We analyzed 263 patients (median TTR, 62.5%). The low-risk group (score 0-1) had a better median TTR as compared with the high-risk group (score ≥ 2): 69.2% vs. 56.3%, p = 0.002. Similarly, the percentage of patients with TTR ≥ 60%, 65% or 70% was higher in the low-risk group (p < 0.001, p = 0.001 and p = 0.003, respectively). The high-risk group had a higher percentage of adverse events (11.2% vs. 7.2%), although not significant (p = 0.369).

Conclusions:

The SAMe-TT₂R₂ score proved to be effective to predict patients with a better TTR, but was not associated with adverse events.

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Percutaneous Mitral Repair with MitraClip® as an Adjunct Therapy of Heart Failure

SAMe-TT2R2 Score: A Useful Tool in Oral Anticoagulation Decision-Making for Venous Thromboembolism Patients?

Abstract

Background:

Objective:

Patients and methods:

Results:

Conclusions:

Prediction Models for Decision-Making on Chagas Disease

SAMe-TT2R2 Score in the Outpatient Anticoagulation Clinic to Predict Time in Therapeutic Range and Adverse Events

Abstract

Background:

Objective:

Methods:

Results:

Conclusions:

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